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Damned and be Unpublished?

John Davies, Douglas Cameron, Ernest Drucker

The Farmington consensus and the " International Society
of Addiction Journal Editors".
This article is derived from two editorials which have been published in
Addiction Research and Theory (AR&T) over the past eighteen months
(Cameron, D. 2001; and Davies, J.B., Drucker, E. & Cameron, D. 2002).
They elucidate the standpoint of that journal with regard to the issue
of conflict of interest in scientific research. We have found ourselves
needing to be explicit because of the presence of a document called "The
Farmington Consensus" (1997) and because of the creation of a body
called the "International Society of Addiction Journal Editors".

Introduction

In the matter of publication of scientific findings, absolute transparency
seems to be the current credo. Those of us who wish to publish our results and
have conflicts of interest should declare them. If we receive funding from some
organisation which is funded by a sect which believes that we are descended from
people from outer space, we should make that clear. And having done so, our
views will be judged accordingly. "Accordingly" means, of course, given less
credence than if our source of funding was more reputable, was, say, a
government funded research council or a worthy charity or public trust. We are
told that conflict of interest is not in itself a crime against science.
Non-declaration of such a conflict is. But who can judge which sources of
funding are worthy and which are not, which conflicts of interest need to be
declared and which do not? That question is particularly cogent in our field,
drug use.

Recently, a new society has been formed; the International Society of
Addiction Journal Editors (ISAJE). On the face of it, this is a laudable
enterprise aimed at bringing together editors of the more than 40 journals that
deal with the scientific and intellectual issues associated with drugs and the
problems that we face in dealing with them. We, the Editors of Addiction
Research and Theory, have declined to join this organisation, and these are the
reasons we gave to our readers why we opted not to join.

In order to become members of that society, journal editors have to make a
set of declarations; some of which are reasonable and benign, but one of which,
in our view, is not. The declarations are as follows.

(The journal) is a peer-reviewed journal, which submits most of the
articles it publishes for review by experts outside its own staff;

(The journal) supports the Farmington Consensus;

(The journal) is not subject to any undeclared institutional conflict of
interest.

We have no problem with points a) and c) but we have difficulties with b),
the requirement that we endorse the Farmington Consensus (1997) an informal
agreement arrived at by a number of addiction journal editors.

Of course if examined on face value, the Farmington Consensus seems worthy.
Who could argue with a statement from a group which has as its declared aim to
enhance the quality of our endeavours in this multidisciplinary field?
Like others in public we are against sin. But in private, we have severe
reservations about the relevance and legitimacy of the so-called evolving
process and its attempt to "define the basis for shared identity, commitment
and purpose among journals publishing in the field of psychoactive substance use
and associated problems". [ibid] In particular, we worry about Clause 3 of
the Commitment to the peer review process (1.3).

Referees should be asked to declare to the editor if they have a conflict
of interest in relation to the material which they are invited to review, and if
in doubt they should consult the editor. We define "'conflict of interest "as a
situation in which professional, personal or financial considerations could be
seen by a fair-minded person as potentially in conflict with independence of
judgement. Conflict of interest is not in itself a wrongdoing. [ibid]

And about Clause 4 of the Expectations of Authors (2.4).

Conflicts of interest experienced by authors: Authors should declare to
the editor if their relationship with any type of funding source might be fairly
construed as exposing them to potential conflict of interest. [ibid]

First, there appears to us to be an unspoken implication behind the Consensus
that certain researchers produce research which is flawed, biased or downright
fraudulent as a consequence of their being dependent on or beholden to certain
sources of funding, Big Booze (BB) and Big Tobacco (BT) being the two prime
sources of concern. Increasingly, of course, the pharmaceutical industry would
also be a candidate for potential conflicts, as we become aware that some of
their products can be a major source of problems. It goes without saying that
some of the manoeuvres perpetrated by BB and BT do not bear close scrutiny, and
that a degree of scepticism or even censure is entirely appropriate with respect
to many of their research and marketing activities. It does not follow, however,
that a similar bias is absent from research funded by "nobler" bodies such as
the cancer foundations, health institutes, research councils and so on. The
assumption that these latter studies are carried out by "scientists" without
bias or prejudice, whose aim is merely to find out the "truth" that emerges
inevitably from data ("the disinterested and objective search for truth") is a
dismal and sorry belief in this day and age; and yet this is exactly the
position advocated by the prime movers of the new society.

So, the purpose of the Farmington Consensus is, bluntly, to separate the good
guys from the bad guys. However, contemporary philosophies of science (as
distinct from 17th century views) see knowledge as relative, and researchers as
motivated individuals whose actions are coloured by their own interests and
beliefs. Obviously, the fact that research is always and inevitably carried out
by individuals with their own agendas and biases, and is influenced
fundamentally by context, creates problems for what we loosely refer to as
"science", but these problems have to be dealt with rather than simply
dismissed. It is clearly utter nonsense to suggest that research takes place in
no context and from no point of view at all.

In the health literature it is possible to find reference to the hired
lackeys of Big Tobacco (or some such phrase); sentiments which some of us would
probably share in specific cases. However, one cannot dismiss all
research from such sources simply because some of it fails to stand up to
scrutiny; just as we cannot accept all research from more respected sources,
simply because of its provenance. If the good guys are characterised as
disinterested and objective, there are no good guys unless they are zombies. To
be alive is to have views and opinions, which guide what one says and does.

The second issue of concern is much simpler. Recent events show clearly just
how the Farmington Consensus can be used, and the purposes to which it can be
put by the members of the ISAJE; that is, as a tool with which to attack
individuals who hold new or unfashionable ideas, and in the process to endanger
careers and destroy reputations. An addiction journal, the editor of which has
been a prime mover both in Farmington and the proposed new Society, recently
took the remarkable step of 'unpublishing' a previously published article (Elleman-Jensen,
P. 1991) on the basis that an undeclared conflict of interest had been
discovered ("the paper may have had an undeclared tobacco industry
connection") which 'therefore' disqualified the article in the interests of "the
integrity of science". No statements were made about the substance, accuracy or
value of the study - merely that its author was somehow tainted. This attempt at
post hoc censorship strikes us as both unwise, and as having
ramifications which are bizarre. Once something is published in the public
domain, it stays in the public domain and can get cited by others in their
papers. Should these be "unpublished" too? Should we expect to see in the list
of publications in our Curricula Vitae entries such as "Published 1988,
Unpublished 2002"? It is clear to us that a paper cannot be removed from the
public domain by the simple expedient of stating that it never, or should never,
have appeared. One wonders just where such a process, once started, might stop;
and how far the criteria for this might extend.

In the event, since the author of the now "unquotable" study has died and is
not able to defend himself, ex-colleagues who are both physically and
academically alive leapt to his defence, and pointed out that the information
about a supposed conflict of interest on which this decision was based was in
fact incorrect (Pedersen, K.M & Christiansen, T. 2002). Had these ex-colleagues
not come to the rescue, a disturbing post mortem destruction of a
reputation would have taken place. Following that defence there was an attempt
to justify the 'unpublishing' course of action embedded in the letters page of a
later issue of that journal (Edwards, G. 2002). Therefore, presumably, the paper
is still meant to be unpublished and uncitable.

More recently, in the same journal, a second related instance has come to
light concerning a book which gives a critical appraisal of the notion of
nicotine addiction. (Frenk, H. & Dar, R. 2000). The text includes
methodologically and historically important criticism of some of the "landmark"
papers, including instances of what appears to be, to all intents and purposes,
fraudulent practise (failing to report data that do not support the argument,
deleting data from subjects that do not behave in the way "required" etc). The
book grew out of interest sparked in the authors who had done a partial review
of the literature which was commissioned by a firm of lawyers one of whose
clients was a tobacco company. That connection was used by the Editors of
Addiction as the justification for a major editorial outcry (N.B. not a book
review) under the banner "Another mirror shattered? Tobacco industry involvement
suspected in a book which claims that nicotine is not addictive" (Edwards, G.,
Babor, T., Hall, W. West, R. 2002). In contrast to that response, on receipt of
the book at AR & T, we delved into its content, reviewed it, and find it to be
an act of considerable scholarship, well worth the reading . We also note on
page 3 of the book a specific authors' statement "that in arguing that nicotine
is not addictive, we have no intention of praising the merits of smoking;" and
on page 4, "We believe it would be rational for everyone to avoid or minimize
smoking because of the short-term and long-term effects on health." Nonetheless,
the authors found themselves on the receiving end of what can only be called a
self-righteous crusade, damning their book because some of the initial source
material was commissioned by a firm of solicitors with tobacco connections. We
are invited to reject the content in its entirety on that basis. In our view
this amounts to nothing less than an attempt to suppress a coherently argued
position and thus to suppress an ensuing open debate which in our view is the
very stuff of scientific discourse.

Readers should also note that the book was not a submitted paper. Whilst
journal editors can of course comment on any book they wish, normally one would
hope through a proper book-review process, the editors of Addiction might well
consider the fact that Farmington applies specifically to publications submitted
to addiction journals and not to the world of publishing as a whole.

We now see that Farmingtoncan be used to disqualify entire bodies of argument
and criticism with which certain people do not agree, on grounds that have
nothing to do with the scientific merit of the work; and to launch retrospective
witch-hunts whereby previously published work can also be disqualified. In our
view, this is morally indefensible. And where would this end? The Frenk and Dar
book was not funded by tobacco (the authors are academics supported by their
research and teaching). The solicitors who paid for the original literature
review had tobacco connections, but the authors simply provided expert evidence
as academics often do, and found the literature wanting. Suppose the solicitors
in question had no tobacco connections, but were in partnership with a firm that
did? Or what if one of their directors worked for two firms, one of which had
such connections? In our minds at least, we can almost hear the sighs of relief
from the "good guys" that a connection had been established. Any connection will
do, no matter how remote, just so long as this body of evidence can be
disqualified at source without having to comment on the content.

In the US many researchers have experienced considerable difficulty getting
funding for studies that employ Harm Reduction - a term that despite being
official policy in many countries, is still proscribed by the US federal
government and its leading drug research agency NIDA - which funds 80% of the
world's research in illicit drugs. This applies also to "recreational drug use"
(which could well constitute 80% of all illicit drug use); studies of
"controlled" alcohol use among former alcoholics (which offends 12 steppers);
and harm reduction approaches to "controlled" (i.e. low level) tobacco smoking,
which was termed "a dangerous idea" in the peer review comments to a grant
application made by one of us (ED) to the US National Cancer Institute. In
addition to restrictions of funding based on the clash between evidence and
official ideology, we also face the difficulties of doing justice to the actual
lives of the majority of drug users - especially the positive experiences and
effects that motivate much non- problematic drug use (e.g. medical marijuana).
Will personal histories of drug use soon become a disqualifying characteristic -
about which assurances, disclaimers, and (soon) urine samples will be expected
along with the submission of an article? And what about the behaviour of one's
associates? This is not an idle concern in the US , where a recent Supreme Court
ruling upholds the eviction from public housing of anyone whose family member
(even if living elsewhere) was found to be using illicit drugs. With the newly
launced Anti Drug campaign linking illicit use to support of terrorism , the
stage is set for all sorts of drug related witch-hunts - now in the name of
national security.

The third and final point is just common sense. We at AR and T wish to
maintain our editorial independence without decisions about what we may or may
not publish being determined by others. We are uneasy about monolithic
across-the-board agreements about what can and cannot be published and believe
these have a poor history (see for instance John Milton's "Areopagitica" speech
of 1644)[1].
At a practical level we have to accept that bias, distortion of facts, good
research, bad research, can come from any source. If authors wish to declare
conflicts of interest we publish them readily, but we do not insist on it.
Everyone has a conflict of interest somewhere, and Farmington merely encourages
the search for it by others with their own vested interests or whenever
something is published with which they disagree. Farmington is thus a
controlling and stifling influence; and we fear it is just those ideas which do
not fit into the easy "addiction" consensus which will be stifled. Science is
always a humbling experience, and the still fairly primitive state of our
understanding and effective control of the nastiest features of drug use and
addiction suggest we have a long way to go before we have mastered that domain.
New and unorthodox ideas that suggest new directions, or inspire us to look
again at received wisdoms, are desperately needed. Meanwhile, in our journal we
have decided that we will continue to use the peer review process to screen out
poor quality research but we would prefer our readers to exercise their own
judgement about the meaning and significance of work published in Addiction
Research and Theory, rather than being denied the opportunity to do so as a
consequence of our Editorial Board handing over its sovereign rights to someone
else.

Notes

In 1644 the poet John Milton published the text of his Areopagitica
speech, an appeal to Parliament to rescind a Press Licensing Order. This
Order sought to bring publishing under governmental control, by creating
a body of censors to whom all work had to be submitted for approval.
Milton argued elegantly that the order represented attempts by the state
to control thought

References

Cameron, D. (2001) Editorial: The End of the Peer Show?
Addiction Research and Theory 9:187-192.